1. PHARYNGITIS AND TONSILITIS

2. Pharyngitis is an inflammatory illness of the mucous membrane and underlying structures of the throat, include tonsillitis, tonsillopharyngitis, and nasopharyngitis. Involved nasopharynx, uvula, and soft palate PHARYNGITIS AND TONSILITIS Definition

3. With nasal symptoms (nasopharyngitis) : virus : - Adenovirus - Influenza virus - Para influenza virus - Enterovirus, coxackievirus, echovirus - Epstein-Barr virus Without nasal symptoms : wide variety  Streptococcal tonsillopharyngitis : Renal, Heart, Rheumatic fever Etiology PHARYNGITIS AND TONSILITIS

4. Infectious agent inoculated  localized inflammation  erythema pharynx, tonsil Exudate : adenovirus, herpes symplex v, S.pyogenes, C.diphteriae, A.haemolyticum, Epstein-Barr virus, and Candida species. Ulceration : herpes symplex v and enterovirus Pathophysiology PHARYNGITIS AND TONSILITIS

5. Pharyngeal involvement overshadowed by other symptom : - cough and coryza (parainfluenza virus) - fever, exanthem, meningitis (enterovirus) Tonsillopharyngeal involvement exudate cause by Epstein-Barr v  group A streptococci  bacterial is the cause of this tonsillitis PHARYNGITIS AND TONSILITIS

6. Usually sudden : fever, sore throat, anorexia. headache, nausea, vomiting, abdominal pain, enlarge & tender cervical lymph node, pharyngeal erythema, follicle, ulcer, petechiae, generalized exudate. Petechial lesions on soft palate : Stafilococcus pyogenes, Epstein-Barr v, measles v, and rubella v. Clinical manifestation PHARYNGITIS AND TONSILITIS

7. Self limited Lasting 4 – 10 days Excellent prognosis 0.3% - 3.0% Streptococcal throat infection  rheumatic fever All cases of acute pharyngitis  streptococcal disease must be considered Clinical distinction unreliable Retropharyngeal/parapharyngeal abscess  complicate bacterial pharyngitis/tonsilitis Nasal infaction, ulceration, and conjunctivitis  viral PHARYNGITIS AND TONSILITIS

8. Throat swab  S. pyogenes Detecting group A streptococcal Ag (10 minutes)  negative  culture Investigation PHARYNGITIS AND TONSILITIS

9. Symptomatic : - drinking warm fluids - saltwater gargles - analgesic - throat lozenges  soothing Decongestants & antihystamines  no place Antibiotic : - S. pyogenes to prevent development rheumatic fever & elemination - Penicillin V oral - Benzathine Penicillin IM - PNC Allergy  Erythromycin - 10 days  efficacy 40 yrs - cephalosporin = PNC Management PHARYNGITIS AND TONSILITIS

10. Adenoidectomy & tonsillectomy -  recurrent sore throat  scientific basis ? - rate  last 2 decades - most important indication : OSA - tonsillar/adenoidal size not always reliable indicator - some benefit  frequent : > 5 episodes / 2 yrs - peritonsillar abscess ?  drainage alone - recurrent / chronic otitis media PHARYNGITIS AND TONSILITIS